Abstract Background Differentiation of bowel wall changes between ischemia and other causes in CT imaging can prove challenging, particularly in colon wall. Therefore, measurement of relative colon wall attenuation and contrast uptake were evaluated for aiding in diagnosis of colon ischemia. Methods CTs with inquiry for bowel ischemia were retrospectively identified. Cases involving colon ischemia or colon wall changes of other etiologies were included. Three regions of interest (ROIs) were placed in representative areas of colon wall with and without evident changes, in arterial and venous phase images, respectively. Means of the ROIs were used to calculate the relative bowel enhancement between affected and unaffected wall in each contrast phase, as well as the contrast uptake of the wall between phases. Relative enhancement and contrast uptake were compared between patients with and without ischemia. A subset of cases was reanalyzed for intra- and inter-reader comparison. Results 31 patients with and 56 patients without ischemia were included. Relative enhancement of affected to unaffected colon wall was -51.2% in arterial phase and -44.6% in venous phase images for patients with ischemia. Relative enhancement was significantly higher in patients without ischemia at -0.5% in both phases ( p < 0.001). There was no significant difference in contrast uptake of affected bowel (40.6% vs. 39.8% respectively, p = 0.67). ROC curves revealed a maximum Youden-Index at a cut-off of -37.4% (AUC: 0.818) in arterial phase to differentiate between groups. Intra-reader comparison showed a good, and inter-reader a moderate, correlation in a subset. Conclusions Objective measurement of relative colon wall attenuation between affected and unaffected areas can be an additional imaging feature to aid in identifying ischemic colon.

Abstract To determine the relationship between mucus plugging and CT-derived parameters of sarcopenia in routine chest CT-scans. Patients with advanced Chronic Obstructive Lung Disease (COPD GOLD 3 or 4) were investigated. Mucus plug score (MPS) and cross-sectional muscle area (CSA) of pectoralis and erector spinae muscle of each patient was assessed by two radiologists. Statistics included non-parametric group comparison, multivariate analysis, and inter- and intrarater agreement. Median age of 123 patients (47 female) was 66 years. In 63 patients (15 females) no mucus plugging was found. 31 patients (15 females) had 1–2 mucus plugs and 29 patients (17 females) had a mucus plug of ≥ 3. PMCSA and ESMCSA were not independently associated with MPS; however, the association between PMCSA and MPS was modified by body weight, with a significant negative correlation between body weight and PMCSA in patients with higher MPS (≥ 3). Inter- and intrarater agreement was very good (ICC 0.899 or higher). Imaging based evaluation of MPS and CSA is reliable on routine chest CT-scans. Patients with more advanced COPD exhibited a higher MPS and larger PMCSA relative to body weight, possibly due to the greater muscular effort required for breathing.

Objectives: Heart failure is an increasing global health problem. Approximately 50% of patients with heart failure have heart failure with preserved ejection fraction (HFpEF) and concomitant diastolic dysfunction (DD), in part caused by increased myocardial stiffness not detectable by standard echocardiography. While elastography can map tissue stiffness, cardiac applications are currently limited, especially in patients with a higher body mass index. Therefore, we developed cardiac time-harmonic elastography (THE) to detect abnormal diastolic myocardial stiffness associated with DD. Material and Methods: Cardiac THE was developed using standard medical ultrasound and continuous external vibration for regionally resolved mapping of diastolic shear wave speed as a proxy for myocardial stiffness. The method was prospectively applied to 54 healthy controls (26 women), 10 patients with moderate left ventricular hypertrophy (mLVH; 5 women), and 45 patients with wild-type transthyretin amyloidosis (wTTR; 4 women), 20 of whom were treated with tafamidis. Ten healthy participants were reinvestigated after 2 to 6 months to analyze test-retest reproducibility by intraclass correlation coefficients. Results: Myocardial shear wave speed was measured with good reproducibility (intraclass correlation coefficient = 0.82) and showed higher values in wTTR (3.0 +/- 0.7 m/sec) than in mLVH (2.1 +/- 0.6 m/sec) and healthy controls (1.8 +/- 0.3 m/sec, all P < .05). Area under the curve values were 0.991 and 0.737 for discriminating wTTR and mLVH from healthy controls, respectively. Shear wave speed was reduced in patients after tafamidis treatment (2.6 +/- 0.6 m/sec, P = .04), suggesting the potential value of THE for therapy monitoring. Shear wave speed was quantified in the septum, posterior wall, and an automatically masked region (here stated for the septal region). Conclusions: Cardiac THE detects abnormal myocardial stiffness in patients with DD with high penetration depth, independent of body mass index and region selection. Based on standard ultrasound components, cardiac THE is cost-effective and has the potential to become a point-of-care method for stiffness-sensitive echocardiography.

In cardiac MRI, the field of view (FOV) is adapted to the individual patient’s size, influencing spatial resolution and myocardial radiomics. This study aimed to investigate the effects of parametric feature maps on radiomics derived from cine images acquired with different FOV sizes on individuals without myocardial pathologies. In the clinical setting, cardiac MRI scans from clinical care were screened retrospectively for patients without pathological findings, neither in the MRI nor the medical history or follow-up, resulting in 61 included patients. In the experimental setting, 12 healthy volunteers were prospectively examined on a 1.5 Tesla MRI scanner with cine images acquired with three different FOVs (256 × 329 mm, 279 × 359 mm, 302 × 390 mm). One midventricular end-diastolic short-axis slice of the non-enhanced cine images was extracted for healthy volunteers and patients. The left ventricular myocardium was encompassed with regions of interest (ROIs). Ninety-three features were extracted using PyRadiomics. Images were converted to parametric radiomic feature maps using pretested software. ROIs were copied to the maps to retrieve the feature quantity. The variability of features across the different FOVs from the original images and feature maps was assessed with coefficients of variation (COVs) and rated stable at up to 10

Background:Chronic obstructive pulmonary disease (COPD) is classified by its clinical phenotypes-chronic bronchitis and emphysema. A computed tomography (CT)-based mucus plug score (MPS) was recently identified as a biomarker to a subgroup of COPD patients with increased airway mucus plugs. While not necessarily linked to more pronounced symptoms or structural lung changes, mucus plugs are associated with increased mortality. Interestingly, a higher MPS seems to be associated with a lower body mass index (BMI), likewise associated with increased mortality. This study aims to characterize patients with advanced emphysema presenting for lung volume reduction therapy with a special focus on mucus plug occurrence. Material and Methods:This retrospective, monocentric study assessed MPS in advanced COPD (Global initiative for chronic Obstructive Lung Disease [GOLD] stages 3 or 4) and emphysema patients evaluated for lung volume reduction therapy at Charité-Universitätsmedizin Berlin. CT scans were analyzed for mucus plugging, and clinical data were obtained from the emphysema registry. Results:A total of 127 CT scans were assessed for MPS. About 50% had no mucus plugs (score = 0), 25% had an intermediate burden (score 1-2), and 25% had a high burden (score ≥3). A higher MPS correlated with a lower BMI, more pronounced emphysema, and worse lung function, including forced expiratory volume in 1 second, vital capacity, and diffusing capacity of carbon monoxide. Residual volume, partial pressure of carbon dioxide, the 6-minute walk test, and quality-of-life parameters were unaffected. Multivariate regression analysis found a strong association between mucus plugs and BMI, showing that a decrease in BMI was associated with a higher mucus burden (p<0.001; coefficient of -1.584). Interpretation:This study supports an association between high MPS and BMI in a vulnerable subgroup of advanced COPD patients. Further research is needed to understand the pathophysiology and consequences of mucus plugs, aiming for individualized risk assessments and treatment strategies.

Background: The relationship between case volume and clinical outcomes is well established for most urological procedures but remains underexplored in prostate ultrasound/MRI fusion biopsy (UMFB). UMFB aims to detect clinically significant prostate cancer (csPCa) by adhering to cancer detection benchmarks for PI-RADS lesions identified via multiparametric MRI (mpMRI). These benchmarks, defined by Ahmed et al., include cumulative cancer detection rate (C-CDR) targets of >80% for PI-RADS 5, >50% for PI-RADS 4, and <20% for PI-RADS 1–3. Methods: This retrospective, single-center study analyzed the case volumes required for two experienced urologists (U1 and U2, each with >15 years of practice) to consistently achieve the Ahmed-defined C-CDR benchmarks for csPCa (ISUP grade ≥ 2) using UMFB. Both transrectal and transperineal approaches were included to enable comprehensive learning curve analysis. Data from 2017 to 2023 were reviewed, encompassing 157 UMFBs performed by U1 and 242 by U2, with a transrectal-to-perineal ratio of 7:3. Results: Both urologists achieved Ahmed-defined C-CDR targets from the outset. Over a median follow-up of 30 months, patients with initial PI-RADS 4 or 5 ratings and negative primary biopsies remained prostate cancer-free in 77% of cases for U1 and 91.2% for U2 (p = 0.152). Conclusions: This study demonstrates that experienced urologists can achieve high diagnostic accuracy and maintain patient safety immediately upon implementing UMFB, meeting established benchmarks without requiring additional procedural learning.

Abstract Background/Introduction Heart failure, including HFpEF, is a growing global health problem. Diastolic dysfunction (DD) is a critical component of HFpEF and is mainly caused by increased myocardial stiffness(1). Current cardiac elastography methods allow the noninvasive quantification of myocardial stiffness(2, 3). Time harmonic elastography (THE) combines conventional ultrasound with continuous external vibrations(4) to generate full field-of-view stiffness maps. Novel, cost-effective cardiac THE (cTHE) with full coverage of the left ventricle (LV) in parasternal long axis view (PLAX) has recently been shown to be sensitive to increased myocardial stiffness in patients with wild-type amyloidosis (wtATTR)(5). Numerous heart diseases are linked to both myocardial stiffening and LV hypertrophy. However, they differ in the underlying pathophysiology such as reactive fibrosis due to pressure overload (hypertension (HT) or aortic stenosis (AS)) or storage disease (ATTR or Fabry disease (FD)). Purpose We aim to investigate the diagnostic value of myocardial stiffness as a quantitative parameter for the characterization of cardiac function independent of wall thickness. Methods 62 participants were enrolled in our study, including 11 healthy controls (age range 27-88 years), 19 patients with HT (age range 44-79 years), 13 patients with AS (age range 61-89 years), 11 patients with wtATTR (age range 64-86 years), 3 patients with HCM (age range 36-70 years) and 5 patients with FD (age range 50-60 years). All subjects underwent a standard echo examination before cTHE (figure 1). Multifrequency vibrations (60,70,80Hz) were induced using a custom portable vibration pillow (Elastance Imaging, Columbus, Ohio, US) underneath the subject’s thorax. A customized ultrasound scanner (GAMPT, Merseburg, Germany) was used for image acquisitions in PLAX with 15cm depth. Images were acquired in breath-hold over 4s with 100Hz frame rate. Measurements were repeated five times. Time-resolved shear wave speed maps (SWS) were generated using k-MDEV inversion(6). Diastolic frames were averaged to obtain a map of diastolic myocardial stiffness. Regions of interest for averaging were manually drawn for the septum and posterior wall. Results Using cTHE, we observed an increase in myocardial stiffness in all groups (Controls: 1.5±0.2ms/s, HT: 1.8±0.4ms/s, AS: 2.0±0.2ms/s, HCM: 2.0±x0.4ms/s, Fabry: 1.9±0.3ms/s, wtATTR: 2.1±0.3ms/s, all p<0.05). SWS correlated with wall thickness only in a pooled analysis (R=0.47, p<0.01), but not within individual groups (figure 2). Conclusions cTHE detects increased myocardial stiffness in a variety of cardiac diseases. Myocardial stiffness is known to be associated with increased wall thickness(7), however our analysis within individual groups showed independence of both parameters. Quantitative assessment of myocardial stiffness could add important diagnostic information to the detection and treatment monitoring of myocardial disease. Figure 1: Setup of cTHE Figure 2: Stiffness Maps/Correlations

Prostate Imaging Reporting and Data System version 2.1 (PI-RADS) category 3 lesions are a challenge in the clinical workflow. A better detection of the infrequently occurring clinically significant prostate cancer (csPCa) in PI-RADS 3 lesions is an important objective. The purpose of this study was to evaluate if feature maps calculated from T2-weighted (T2w) 3 Tesla (3T) MRI can help detect csPCa in PI-RADS category 3 lesions. In-house biparametric 3T prostate MRI examinations acquired between January 2019 and June 2023 because of elevated prostate-specific antigen (PSA) levels were retrospectively screened. Inclusion criteria were a PI-RADS 3 lesion and available results of an ultrasound-guided targeted and systematic biopsy. Exclusion criteria were a simultaneous PI-RADS category 4 or 5 lesion and hip replacement. Target lesions with the International Society of Urological Pathology (ISUP) grade group 1 were rated clinically insignificant PCa (ciPCa) and ≥2 csPCa. This resulted in 52 patients being included in the final analysis, of whom 11 (21.1%), 8 (15.4%), and 33 (63.5%) patients had csPCa, ciPCa, and no PCa, respectively, with the latter two groups being combined as non-csPCa. Eight of the csPCas were located in the peripheral zone (PZ) and three in the transition zone (TZ). In the non-csPCa group, 29 were located in the PZ and 12 in the TZ. Target lesions were marked with volumes of interest (VOIs) on axial T2w images. Axial T2w images were then converted to 93 feature maps. VOIs were copied into the maps, and feature quantity was retrieved directly. Features were tested for significant differences with the Mann–Whitney U-test. Univariate models for single feature performance and bivariate models implementing PSA density (PSAD) were calculated. Ten map-derived features differed significantly between the csPCa and non-csPCa groups (AUCs: 0.70–0.84). The diagnostic performance for TZ lesions (AUC: 0.83–1.00) was superior to PZ lesions (AUC: 0.74–0.85). In the bivariate models, performance in the PZ improved with AUCs >0.90 throughout. Parametric feature maps alone and as bivariate models with PSAD can (?) noninvasively identify csPCa in PI-RADS 3 lesions and could serve as a quantitative tool reducing ambiguity in PI-RADS 3 lesions.

Purpose: This retrospective study aimed to investigate the epicardial fat volume in cardiac computed tomography (CT), its relationship with cardiac arrhythmias, and its correlation with the coronary artery disease reporting and data system (CAD -RADS) score. Material and methods: Ninety-six patients who underwent CT coronary angiography (CTCA) were included in this study. Patient data, including demographic information, clinical history, and imaging data were collected retrospectively. Epicardial fat volume was quantified using a standardised algorithm, the CAD -RADS scoring system was applied to assess the extent of coronary artery disease (CAD). Descriptive statistics, correlation analyses, and receiver operating characteristics methods were used. Results: The study found a significant correlation between epicardial fat volume and CAD -RADS score (r(2) = 0.31; p < 0.001), indicating the known influence of epicardial fat on CAD risk. Moreover, patients with higher epicardial fat volumes were more likely to experience cardiac tachyarrhythmia (p < 0.001). Receiver operating characteristic analysis established a threshold value of 123 cm(3) for epicardial fat volume to predict tachyarrhythmia with 80% sensitivity (AUC = 0.69). Conclusions: In this study a volume of at least 123 cm(3) epicardial fat in native coronary calcium scans is associated with cardiac tachyarrhythmia. In these patients, careful selection of suitable imaging protocols is advised.

OBJECTIVES:Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 is a clinical and research standard for evaluating malignant tumors and lymph node metastasis. However, quantitative analysis of nodal status is limited to measurement of short axis diameter (SAD), and metastatic lymph nodes below 10 mm in SAD are often not detected. The purpose of this study was to evaluate the value of multifrequency magnetic resonance elastography (MRE) when added to RECIST 1.1 for detection of lymph node metastasis. MATERIALS AND METHODS:Twenty-five benign and 82 metastatic lymph nodes were prospectively examined by multifrequency MRE at 1.5 T using tomoelastography postprocessing at 30, 40, 50, and 60 Hz (total scan time of 4 minutes). Shear wave speed as a surrogate of soft tissue stiffness was provided in m/s. Positron emission tomography-computed tomography was used as reference standard for identification of abdominal lymph node metastasis from histologically confirmed primary tumors. The diagnostic performance of MRE was compared with that of SAD according to RECIST 1.1 and evaluated by receiver operating characteristic curve analysis using generalized linear mixed models and binary logistic mixed models. Sensitivity, specificity, and predictive values were calculated for different cutoffs. RESULTS:Metastatic lymph nodes (1.90 ± 0.57 m/s) were stiffer than benign lymph nodes (0.98 ± 0.20 m/s, P < 0.001). An area under the curve of 0.95 for a cutoff of 1.32 m/s was calculated. Using a conservative approach with 1.0 specificity, we found sensitivity (SAD/MRE/MRE + SAD, 0.56/0.84/0.88), negative predictive values (0.41/0.66/0.71), and overall accuracy (0.66/0.88/0.91) to be improved using MRE and even higher for combined MRE and SAD. CONCLUSIONS:Multifrequency MRE improves metastatic abdominal lymph node detection by 25% based on higher tissue stiffness-even for lymph nodes with an SAD ≤10 mm. Stiffness information is quick to obtain and would be a promising supplement to RECIST.

Tissue characterisation using T1 mapping has become an established magnetic resonance imaging (MRI) technique to detect myocardial diseases. This retrospective study aimed to determine the influence of left bundle branch block (LBBB) on T1 mapping at 1.5 T. Datasets of 36 patients with LBBB and 27 healthy controls with T1 mapping (Modified Look-Locker inversion-recovery (MOLLI), 5(3)3 sampling) were included. T1 relaxation times were determined on mid-cavity short-axis images. R 2 maps were generated as a pixel-wise indicator for the goodness of the fit of T1 maps. R 2 values were significantly lower in patients with LBBB than in healthy controls (whole myocardium/septum, 0.997, IQR, 0.00 vs. 0.998, IQR, 0.00; p = 0.008/0.998, IQR, 0.00 vs. 0.999, IQR, 0.00; p = 0.027). Manual correction of semi-automated evaluation tended to improve R 2 values but not significantly. Strain analysis was performed and the systolic dyssynchrony index (SDI global ) was calculated as a measure for left ventricular dyssynchrony. While MRI is generally prone to artefacts, lower goodness of the fit in LBBB may be mainly attributable to asynchronous contraction. Therefore, careful checking of the source data and, if necessary, manual post-processing is important. New techniques might improve the goodness of the fit of T1 mapping by reducing sampling in the motion prone diastole of LBBB patients.

Background Stroke aetiology remains cryptogenic in a relevant proportion of patients with acute ischaemic stroke (AIS). We assessed whether enhanced diagnostic workup after AIS yields a higher rate of prespecified pathological findings compared with routine diagnostic care in-hospital. Methods Hospitalised patients with AIS were prospectively enrolled in the investigator-initiated observational HEart and BRain Interfaces in Acute Ischaemic Stroke (HEBRAS) study at the Charité, Berlin, Germany. Patients with AIS without known atrial fibrillation (AF) underwent cardiovascular MR imaging (CMR), MR-angiography of the aortic arch and prolonged Holter-ECG monitoring on top of routine diagnostic care. Results Among 356 patients with AIS (mean age 66 years, 37.6% female), enhanced workup yielded a higher rate of prespecified pathological findings compared with routine care (17.7% vs 5.3%; p<0.001). Consequently, fewer patients were classified as cryptogenic after enhanced diagnostic workup (38.5% vs 45.5%, p<0.001). Routine care included echocardiography in 228 (64.0%) patients. CMR was successfully performed in 292 (82.0%) patients and revealed more often a prespecified pathological finding compared with routine echocardiography (16.1% vs 5.3%). Furthermore, study-related ECG monitoring (median duration 162 hours (IQR 98–210)) detected AF in 16 (4.5%) patients, while routine monitoring (median duration 51 hours (IQR 34–74)) detected AF in seven (2.0%) patients. Conclusions Enhanced diagnostic workup revealed a higher rate of prespecified pathological findings in patients with AIS compared with routine diagnostic care and significantly reduced the proportion of patients with cryptogenic stroke. Trial registration number NCT02142413 .

Background:Differentiating inflammatory from malignant lung lesions continues to be challenging in clinical routine, frequently requiring invasive methods like biopsy. Therefore, we aimed to investigate if inflammatory and malignant pulmonary lesions could be distinguished noninvasively using radiomics of apparent diffusion coefficient (ADC) maps and radiomic feature maps calculated from T2-weighted (T2w) 3 Tesla (3T) magnetic resonance imaging (MRI) of the lung.Methods:Fifty-four patients with an unclear pulmonary lesion on computed tomography (CT) were prospectively included and examined by 3T MRI with T2w and diffusion-weighted sequences (b values of 50 and 800). ADC maps were calculated automatically. All patients underwent biopsy or bronchoalveolar lavage (BAL). Sixteen patients were excluded (e.g., motion artifacts), leaving 19 patients each with malignant and inflammatory pulmonary lesions. Target lesions were defined by biopsy or as the largest lesion (BAL-based pathogen detection), and two readers placed volumes of interest (VOIs) around the lesions on T2w images and ADC maps. One hundred and seven features were conventionally extracted from the ADC maps using PyRadiomics. T2w images were converted to 107 parametric feature maps per patient using a PyRadiomics-based, pretested software tool developed by our group. VOIs were copied from T2w images to T2 maps for feature quantification. Features were tested for significant differences using the Mann-Whitney U-test. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and interreader agreement by intraclass correlation coefficients (ICCs).Results:Fifty-eight features derived from ADC maps differed significantly between malignant and inflammatory pulmonary lesions, with areas under the curve (AUCs) >0.90 for 5 and >0.80 for 27 features, compared with 67 features from T2 maps (5 features with AUCs >0.80). ICCs were excellent throughout.Conclusions:ADC and T2 maps differentiate inflammatory and malignant pulmonary lesions with outstanding (ADC) and excellent (T2w derived feature maps) diagnostic performance. MRI could thus guide the further diagnostic workup and a timely initiation of the appropriate therapy.

Different volume of interest (VOI) sizes influence radiomic features. This study examined if translating images into feature maps before feature sampling could compensate for these effects in liver magnetic resonance imaging (MRI). T1- and T2-weighted sequences from three different scanners (two 3-T scanners, one 1.5-T scanner) of 66 patients with normal abdominal MRI were included retrospectively. Three differently sized VOIs (10, 20, and 30 mm in diameter) were drawn in the liver parenchyma (right lobe), excluding adjacent structures. Ninety-three features were extracted conventionally using PyRadiomics. All images were also converted to 93 parametric feature maps using a pretested software. Agreement between the three VOI sizes was assessed with overall concordance correlation coefficients (OCCCs), while OCCCs > 0.85 were rated reproducible. OCCCs were calculated twice: for the VOI sizes of 10, 20, and 30 mm and for those of 20 and 30 mm. When extracted from original images, only 4 out of the 93 features were reproducible across all VOI sizes in T1- and T2-weighted images. When the smallest VOI was excluded, 5 features (T1-weighted) and 7 features (T2-weighted) were reproducible. Extraction from parametric maps increased the number of reproducible features to 9 (T1- and T2-weighted) across all VOIs. Excluding the 10-mm VOI, reproducibility improved to 16 (T1-weighted) and 55 features (T2-weighted). The stability of all other features also increased in feature maps. Translating images into parametric maps before feature extraction improves reproducibility across different VOI sizes in normal liver MRI. The size of the segmented VOI influences the feature quantity of radiomics, while software-based conversion of images into parametric feature maps before feature sampling improves reproducibility across different VOI sizes in MRI of normal liver tissue. • Parametric feature maps can compensate for different VOI sizes. • The effect seems dependent on the VOI sizes and the MRI sequence. • Feature maps can visualize features throughout the entire image stack.

Introduction: Cardiac biomarkers, such as high-sensitivity cardiac troponin T (hs-cTnT), are frequently elevated in ischemic stroke patients but the mechanisms underlying this elevation are insufficiently understood. We determined the presence of cardiac damage, assessed using cardiac magnetic resonance imaging (CMR), in stroke patients with elevated hs-cTnT and brain natriuretic peptide (BNP). Methods: This is a post hoc analysis of the prospective, investigator-initiated, cross-sectional HEart and BRain interfaces in Acute Stroke (HEBRAS) study. All patients underwent the measurement of hs-cTnT and BNP as well as gadolinium-enhanced CMR in the acute phase of ischemic stroke. We performed unadjusted and adjusted logistic regression models to assess the association between hs-cTnT and BNP elevation and the presence of pathological CMR findings. Results: Two hundred and thirty-three stroke patients (median age 67 years, 33% female) were included, of whom 43 (21%) had elevated hs-cTnT and 109 (47%) had elevated BNP. Hundred of the 233 (43%) patients had pathological findings on CMR had focal fibrosis as detected by late-gadolinium enhancement (LGE) in 51 (23%), left-ventricular hypertrophy (LVH) in 38 (16%), reduced LVEF in 32 (14%), and left-atrial dilatation in 34 (15%). After adjustment for potential confounders, both hs-cTnT (adjOR 5.0 (95%CI 2.1–11.7), p < 0.001) and BNP (adjOR 4.1 (95%CI 2.3–7.3), p < 0.001) were significantly associated with pathological findings on CMR. Hs-cTnT was associated with LGE, LVEF, and LVH, whereas BNP was associated with left-atrial dilatation and LVEF, LVH. Conclusion: Elevated cardiac biomarkers in acute stroke including CMR are strongly associated with pathological findings on CMR. In acute stroke patients, the elevation of cardiac biomarkers may identify patients who require a more thorough cardiology work-up.